HomeMy Public PortalAbout9173 WOOLLEY ST_Plumbing__ :E:;',"(=_.o) APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING
ADDRESS
NUMBER FIXTURE OR ITEM • FEE
LOCALITY ,
WATER CLOSET r' r i •'
NEAREST Y
BATH TUB CROSS ST. C.
i C
SHOWER OWNER rf u
LAVATORY MAIL
ADDRESS I J
SINK CITY" c ti — TEL.NO—'. LL
DISHWASHER }
CONTRACTOR ;' / i- ✓=
• Q
CLOTHES WASHER ti ADDRESS t
U
SWIMMING POOL RECEPTOR CL
CITY TEL.NO. ;' z
LAWN SPRINKLER SYSTEM STATE — LIC. w
WATER HEATER LICENSE NO. CLA" ~
DISTRICT NO. .,PROCESSED BY
GAS SYSTEM OUTLETS �y ✓ !
OUTLETS OVER
5 PER SYSTEM
FINALS-.ZZ
DATE L VALIDATION..
l
FINAL
BY
Plan check fee '
PLUMBING PERMIT ISSUING FEE$ L D —
TOTAL FEE
Pian check applicant ✓,�.���-
Name
Address
City Tel.No.
•
�}r r
i • i V'
SEE REVERSE FOR EXPLANATORY LANGUAGE
WORKERS'COMPENS T/} ION DECLARATION APPLICATION FOR PLUMBING PERMIT
1 hereby, affirm that I haver b c'a fiicate of consent to self in- 76�A
sure,or a certificate of Waersr C pensation Insurance,or a
certified copy thereof(Sec. 3800, Lab. C.)
COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
Policy No. Company
F1 Certified copy is hereby furnished.
Certified co is filed with the count building P FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING �/ i>�
copy• y gins action ADDRESS �/
department. NUMBER FIXTURE OR ITEM @ FEE
LocAury
Ddte Applicant WATER CLOSET(TOILET) NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS'
BATH TUB CROSS ST.
COMPENSATION INSURANCE SHOWER OWNER
(This section need not be completed If tho work involved by MAIL
the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS 4q 1 45,W.U.&N sr
I certify that in the performance of the work for which this per- SINK CI TEL.NO
mit is issued, I shall not employ any person in any manner so
as to become subject to the Workers'Compensation Laws. DISHWASHER
CONTRACTOR
Date Applicant CLOTHES WASHER
ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate of Ex-
,you em tionshould become subject to the Workersen-'Com SWIMMING POOL RECEPTOR
P Y I p CITY TEL.NO.
sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS
ly with such provisions or this permit shall be deemed revok- STATE LIC.
ed. W TER H • LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSEb BY
I hereby affirm that I am licensed under provisions of Chapter ASS TEM /OUTLETS /6- 0_ &I—Ar p
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER Gtr
and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL / VALIDATION
fect. HOSE BIB DATE (r'J
License Number Lic. Class 0
FINAL
Contractor Date BY
I am exempt under Sec. V
B.BP.C. for this reason Plan check fee ® 9L
Date: 9� O 2E
PLUMBING PERMIT ISSUING FEE$ oT
Signature TOTAL FEE
SINGLE FAMILY r
HOME OWNER-BUILDER.DECLARATION Pian check applicant
I hereby affirm that I am exempt from the Contractor's License Name A%A1 i °4
Law for the following reason (Section 7031.5, Business and
Professions Code): Address 7-1— `t -5
Professions
Lpr I, as owner of the property, will do the work and the City Tel. No. f _
structure is not intended or offered for sale(Section 7044, TOTAL r a=a
Business and Professions Code). ®
CONSTRUCTION LENDING AGENCY CHECK 1.sc�
I hereby affirm that there is a construction lending agency for CHANGE °GO
the performance of the work for which this permit is issued
(Sec. 3097, Civ. C.).
0009-008� / 5l9,t
Lender's Name 51395 1 AM 8-'51
eO1
Lender's Address
I certify that I have read this application and state that the
above information is correct. I agree to comply with all County
ordinances and State laws regulating Plumbing, and hereby
authorize representatives of this County to enter upon the
above-mentioned erty for i pection purposes.
a// I .5_(9 -Di SEE REVERSE FOR EXPLANATORY LANGUAGE
ignature Permit ee Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0904070003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
ON FILE 9073 WOOLLEY ST
]FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:] TEMP CA 917801348
ASSESSOR INFORMATION NUMBER: ] ] NEAREST CROSS STREET:
15382-019-030 101 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY, Cl
] 107 BATHTUBS/SHOWERS 2.00 FIX 32.40 ]
TENANT: 125 LAVATORIES/SINKS 2.00 FIX 32.40 JISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
] 145 WATER CLOSET/URINAL 2.00 FIX 32.40 104/07/09 SR 10/04/09
] ] TOTAL FEES 124.95 ]
(OWNER: TEL. NO: ] ]F AL DATE FINAL BY: CODE:
WEAL GEORGE L;JOANNE M (626) 285-3796- ]
19073 WOOLLEY ST ]
TEMP 917801348 ]D SCRIPTI N OF WORK
PLUMBING FOR 2 BATHROOMS REMODEL
APPLICANT: TEL. NO:
HOME CARE & DESIGN (888) 580-5557-
110680 W. PICO BLVD. SPECIAL CONDITIONS:
]LOS ANGELES CA 90064
CONTRACTOR: TEL. NO: ]APPROVALS DATE INSPECTOR SIGNATURE ]
HOME CARE AND DESIGN (888) 580-5557- ] ]
110680 W PICO BLVD LIC. NO ]UNDER SLAB WORK
LOS ANGELES/CA/90064 820230
] IWATER SERVICE
] IPLASTIC YIN METAL YIN
ARCHITECT OR ENGINEER: TEL. NO: ]
- ]ROUGH PLUMING
LIC. NO: F I ]
] ]GAS PIPING I I ]
] ] ]GAS VENT i ] ]
] HOT WATER HEATER
] ] ] ] ]
] ] ]PLUNKING FIXTURES ] ] ]
] ] ]LAWN SPRINKLERS ] I ]
] ] ]GAS TEST ] I ]
] I ]UTILITY COMPANY NOTIFIEDi ] ]
] ] ICwv ] ] ]
] I ]GRAY WATER SYSTEM ] ] ]
] ]REPORT ID: DPR263 ROUTE TO: BS0508 ] ] ] ]